Neurologic manifestations in emerging arboviral diseases in Rio de Janeiro City, Brazil, 2015-2016

Abstract

Introduction: Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases reported in 2015-2016, some with neurological disorders. Methods: Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results. Results: In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratoryconfirmed, of which 57.1% were chikungunya-positive. Conclusions: Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.

Guillain-Barré syndrome related to Zika virus infection: A systematic review and meta-analysis of the clinical and electrophysiological phenotype

“…All but one study reported the presence of clinical symptoms of infection. [19] Two or more symptoms were present in 91% of cases (378/444; 95%CI 84-96, I 2 61.2%). The most common symptoms were rash, fever and arthralgia, with similar pooled frequencies between overall estimates and the probable/confirmed subgroup ( Table 4).…”

“…The median age of the study populations varied between 34 and 61 years, and only 11 pediatric patients were included in four studies. [19,24,27,30] The majority of patients was male (62%) and the male:female ratio of all studies combined was 1.63. In multicenter studies or those including all GBS cases in the reference population, the male:female ratio was 1:1, with the exception of studies from French Polynesia [4] and Martinique [26], which had ratios of 3:1 and 2:1, respectively ( Table 3).…”

“…[16][17][18][19][20][21][22] Six studies included all GBS patients in their reference population, [4,15,[23][24][25][26] one study included all GBS patients >12 years old, [27] and one study included all arbovirus-related neurologic manifestations. [19] All other studies included a convenience sample of patients seen at one or more health-care centres. Three studies only included patients admitted to the ICU, [17,22,28] and nine studies only included GBS patients with a clinical suspicion or laboratory evidence of a ZIKV infection.…”

“…Regarding the ascertainment of ZIKV infection, 13 studies tested their cases for both PCR and IgM, [4, 14-18, 21, 25, 26, 28, 30, 31, 33] five only for PCR, [19,20,22,29,32] and three only for IgM. [23, 24, 27] Based on the CDC ZIKV case definition, more than a half of all GBS cases with this data available had a suspected ZIKV infection (324/570, 57%), which gives a high risk for ascertainment bias within studies and heterogeneity across studies.…”

“…Separate data on tetraparesis vs paraparesis were reported in ten studies. [4, 16-18, 20, 21, 23, 25, 27, 31] Paraparesis was present in 69 of 251 reported cases (24% 95%CI [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. This included reports of cases with only lower limb weakness at nadir (30/251), cases with only lower limb weakness at an unclear time point in the disease (33/251), and cases that were reported as having a paraparetic variant of GBS (6/251).…”